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PT fundamentals > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is gait?

A

The manner in which a person walks

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2
Q

What is a step?

A

From the heel strike of one foot to the next heel strike of the contralateral (opposite) foot

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3
Q

What is step length?

A

The distance between steps

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4
Q

What is a stride?

A

From the heel strike of one foot to the next heel strike of the ipsilateral (same) heel strike. (lasts 1 sec)

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5
Q

What is speed?

A

The rate of linear forward motion of the body

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6
Q

What is cadence?

A

The number of steps taken per unit of time. Steps/min

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7
Q

What is the general cadence for adult men

A

110 steps/min

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8
Q

What is the general cadence for adult women

A

116 steps/min

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9
Q

What is the general cadence for start of jogging/running

A

180 steps/min

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10
Q

How do you increase gait speed?

A

By increasing stride length, & cadence

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11
Q

What is a step width?

A

The linear distance between midpoint of heel of one foot and the same point on the other foot completing the step.

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12
Q

What is the general step width?

A

Usually 3 and half inches, but can vary from 1-5 inches

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13
Q

The step width is ____ in elderly and infants

A

Wider/larger

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14
Q

What are the phases of the gait cycle?

A

Initial contact, loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing, and terminal swing

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15
Q

What percent is the stance phase of the total gait cycle?

A

62%

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16
Q

What percent is the swing phase of the total gait cycle?

A

38-50%

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17
Q

What is initial contact in the phases of gait?

A

The moment when the foot contacts the ground

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18
Q

What is loading response in the phases of gait?

A

Weight rapidly transferred onto outstretched limb

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19
Q

What is mid stance in the phases of gait?

A

Body progresses over a single, stable limb

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20
Q

What is terminal stance in the phases of gait?

A

Body moves ahead of limb and weight is transferred to forefoot. Rapid unloading of limb occurs as weight is transferred to contralateral(opposite) limb

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21
Q

What is pre-swing in the phases of gait?

A

Thigh begins to advance as foot comes off the floor

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22
Q

What is initial swing in the phases of gait?

A

Thigh begins to advance as foot comes off the floor

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23
Q

What is mid swing in the phases of gait?

A

Thigh continues to advance as the knee begins to extend

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24
Q

What is terminal swing in the phases of gait?

A

Knee extends as the limb prepares for the contact with the ground.

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25
Q

What is happening in the other limb when the reference limb is going through initial contact and loading response?

A

Pre-swing

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26
Q

What is happening in the other limb when the reference limb is going through mid-stance?

A

Initial swing and 1st part of mid swing

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27
Q

What is happening in the other limb when the reference limb is going through terminal stance?

A

2nd part of mid swing and terminal swing

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28
Q

What is happening in the other limb when the reference limb is going through pre- swing?

A

Initial contact and loading response

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29
Q

What is happening in the other limb when the reference limb is going through initial swing and 1st part of mid-swing?

A

Mid-stance

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30
Q

What is happening in the other limb when the reference limb is going through 2nd part of mid-swing and terminal swing?

A

Terminal stance

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31
Q

Loading response(2nd phase) begins with ____ and ends with __

A

Begins with foot contact and ends with opposite limb toe off

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32
Q

Mid stance(3rd phase) begins with ___ and ends with ___

A

Begins with opposite limb toe off and ends with ipsilateral heel rise

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33
Q

Terminal stance(4th phase) begins with ___ and ends with ____

A

Begins with ipsilateral heel rise and ends with opposite limb foot contact

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34
Q

Pre swing starts(5th phase) with __ and ends with ___

A

Starts with opposite foot contact and ends with ipsilateral toe off

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35
Q

Initial swing (6th phase) starts with ___ and ends with ____

A

Starts with ipsilateral toe off and ends when the medial malleoli are aligned

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36
Q

Mid swing (7th phase) begins with ___ and ends with ____

A

Begins with the medial malleoli aligned and ends when the ipsilateral tibia is perpendicular to the ground

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37
Q

Terminal swing (8th phase) begins with ___ and ends with ___

A

Begins with the tibia perpendicular to the floor and ends when the ipsilateral foot strikes the floor

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38
Q

Where should the PT be positioned during gait training?

A

Behind the patient and to the side that is being treated. Place one hand with a supinated grip and the other hand in front of the shoulder

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39
Q

What assistive devices should be used with 3-point gait?

A

Crutches or walker

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40
Q

Assisted devices to use for a patient that has one leg affected and full weight bearing on the other leg is ___

A

Crutches or a front wheeled walker

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41
Q

For a patient with no weight bearing restrictions, ____ can be used

A

Bilateral canes

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42
Q

Where in the 5 elements of patient management does the subjective exam fall?

A

Examination and evaluation

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43
Q

What is the primary objective of the initial PT visit called?

A

Phase 1 differential diagnosis

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44
Q

What question is asked in the Phase 1 differential diagnosis?

A

Does this patient belong in my clinic?

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45
Q

Will the subjective exam ever need to come back in play?

A

Yes

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46
Q

What is the typical subjective exam flow?

A
  1. Review Baseline Information/Chart Review
  2. Establish Rapport
  3. Gather General Information
  4. Analyze Information/ Hypothesis Generation
  5. Gather Specific Information
  6. Plan Objective Exam
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47
Q

80% of info needed to make a diagnosis is contained in the ___

A

Subjective exam

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48
Q

What happens in the Review Baseline Information/Chart Review of the subjective exam flow?

A

• Provides needed information, like:

  • General Health Status
  • Imaging findings
  • Operative reports
  • Past medical history and/or treatments
  • Medications
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49
Q

What part of the subjective flow may be the examination?

A

Review Baseline Information/Chart Review

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50
Q

What happens in the Establish Rapport of the subjective exam flow?

A 
• Welcoming introductions
• Establish effective communication and
rapport
• Explanation of perspective
• Clarification of patient expectations
• Sequence of first session – exam process and patients role
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51
Q

What happens in the gather general information step of the subjective exam flow?

A
  • Patient profile (age, gender…)
  • Chief complaint
  • Body chart
  • Present Episode
  • Past History
  • Aggravating/Easing Factors
  • Relationship between regions
  • 24-hour behavior
  • Patient Goals
  • Patient Expectations
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52
Q

The ___ fills out the body chart

A

The patient

53
Q

Problem area characteristics of of the body chart

A
  • Location of each area of pain / symptoms
  • Quality / Type of symptoms
  • Depth of symptoms
  • Frequency / Constancy of symptoms
  • Relationships between areas of symptoms
  • Clearing relevant areas
54
Q

What are the two pain rating scales?

A
  • Numerical Pain Rating Scale (NPRS): o a scale of 1-10

- Visual Analog Scale (VAS) for pain

55
Q

Which pain rating scale is used the most?

A

The NPRS

56
Q

What are radicular symptoms?

A

direct stimulation of a nerve root results

in a sharp, lancinating pain, well-localized to the dermatome.

57
Q

What is a visceral referral symptom?

A

kidney, pancreas, cardiac, etc. - can mimic or masquerade as musculoskeletal pain.

58
Q

What is a somatic referral symptom?

A 
symptoms that arise from referral of a
musculoskeletal structure (i.e. facet jt.)
59
Q

What is a trigger point symptom?

A

hypersensitive spot typically in skeletal muscle that can be associated with a taut band

60
Q

What happens in the gather specific information step of the subjective exam flow?

A
  • Date of onset
  • Mode of onset (injury, any precipitating factors?)
  • Gradual onset
  • Sudden onset
  • Immediate or delayed symptoms after injury?
  • Pain and Swelling
  • Are symptoms getting better, worse, or status quo?
  • Any treatment to date? Effects?
  • 24-hour behavior
61
Q

What are the two factors of the behavior of symptoms that are very important?

A
  • Aggravating and easing factors
62
Q

What is a systems review?

A

Where we are asking questions that relate to the different systems of a given patient

63
Q

What does a systems review do?

A

It helps us identify red flags

64
Q

What are red flags?

A

Signs and/or symptoms that may warrant immediate communication with the referring provider or may warrant a referral/consultation to another healthcare
practitioner

65
Q

The present of a single red flag is usually ____ and must be ___

A

Not much of a concern, and must be put into context with the rest of the patient’s presentation(age, gender, med history…)

66
Q

What is a category 1 red flag?

A

Factors that require immediate medical attention

67
Q

What is a category 2 red flag?

A

Factors that require subjective questioning and precautionary examination and treatment procedures

68
Q

What is a category 3 red flag?

A

Factors that require further physical testing and differential analysis

69
Q

What is a yellow flag?

A

Factors that increase the risk of developing, or perpetuating long-term disability and work loss

70
Q

A yellow flag may warrant ___

A

May warrant a referral/consultation to a mental health practitioner

71
Q

Examples of a yellow flag

A

Psychosocial issues:

  • Fear avoidant behavior
  • Pain catastrophizing
  • Loss of pleasure in doing things, feeling hopeless
  • High levels of anxiety
  • Suicidal ideation
72
Q

What do we do to further refine our hypothesis of a patient?

A

Establish SINSS

73
Q

What does SINSS stand for?

A 
Severity
Irritability 
Nature 
Stage 
Stability
74
Q

What is severity?

A

The intensity of the patients symptoms as they relate to a functional activity

75
Q

How is severity rated?

A

• Minimal = Minimal to no pain (0-3/10), symptoms do not limit or hinder activity

• Moderate = Pain reduces activity levels to 40-70% of normal, pain
rated at 4-7/10

• High = Pain symptoms severely reduce or stop activities; ADLs are
are avoided or severely limited, pain rated at 8-10/10

76
Q

What is irritability?

A

Time for symptoms to come on and go away

77
Q

How is irritability rated?

A
  • Low = Tolerates repetitive or sustained activities, can cont. activity after the onset of pain, pain eases in short amount of time
  • Moderate = Tolerates brief activities or positions < 10 min, cont. light activities after the onset of pain, pain eases in similar time as onset (may be longer)
  • High = Activity not tolerated – are avoided, unable to continue activity after the onset of pain, symptoms takes a long time to ease (>30 minutes)
78
Q

What are the two types of nature of a pain?

A

• Musculoskeletal vs. Non-Musculoskeletal

79
Q

The type of pain often relays information to the clinician regarding the _____

A

type of tissue involved

80
Q

The nature of pain is a reflection of ____

A

differential diagnosis and systems review

81
Q

What is the stage?

A

Time frame since the onset of symptoms

82
Q

What are the stages of pain?

A
  • Acute pain: Recent onset (0-6 weeks)
  • Sub-acute pain: Pain may be due to later stages of tissue healing or early stages of developing chronic symptoms (6-12 weeks).

• Chronic pain: Longer duration – usually past expected recovery time
(> 3 months)

83
Q

What is stability?

A

The progression of the patients pain (or symptoms) over time

84
Q

What are the ways to classify the stability of a patient’s pain?

A

Is the patients pain:
• Getting better
• Staying the same
• Getting worse

85
Q

If a patient has a high severity & irritability we may ____

A

Limit the SINSS, so as to not make them worse

86
Q

If a patient has a low irritability we may ____

A

Not limit the exam, so as to reproduce the symptoms

87
Q

Other things SINSS helps us understand

A
  • Contraindications to the examination?
  • Vigor of exam?
  • Which structures will I examine?
  • Will I do a neurological exam?
  • Which examination techniques will I perform?
88
Q

What are the reasons to screen a patient?

A

• Sicker patient/client base: more comorbidities
• Quicker: earlier mobility/discharge of hospital pts same day
surgery
• Disease progression
• Patient/client disclosure
• Presence of one or more yellow (caution) or red (warning) flags
• Direct Access: people coming off the street

89
Q

What is direct access?

A

The right of the public to obtain examination, evaluation and intervention from a licensed PT w/out previous examination by or referral from a physician, gatekeeper or other practitioner

90
Q

What is primary care?

A

“…integrated, accessible healthcare by clinicians
who are accountable for addressing a large
majority of personal health care needs,
developing sustained partnerships with
patients…”

91
Q

What is a diagnosis?

A

Recognition of disease/disorder usually via a collection of relevant signs and symptoms

92
Q

What is a differential diagnosis?

A

Systematic method to identify the cause

(MSK or non-MSK) of a patient’s symptoms

93
Q

What is a prognosis?

A

Predicted optimal level of improvement in function taking in consideration of comorbidities, motivation, psychosocial
factors, patient values/goals

94
Q

What are constitutional signs?

A

are general signs/symptoms that are present when illness is present

95
Q

What are the means of communication?

A
  • Verbal
  • Non-verbal
  • Written
96
Q

Verbal cues convey ___ of the message

A

7%

97
Q

Vocal cues are __ of communication

A

38%

98
Q

Facial cues are __of communication

A

55%

99
Q

What is effective communication?

A

Message sent = message received.

New information makes sense to a person by
comparing it to what is already in their minds

100
Q

Sources of communication error

A
  • Language
  • Psychological (listener)
  • Environmental
  • Speech (speaker)
101
Q

Questioning techniques

A

• Speak slowly
• Speak deliberately
• Keep questions short
• Ask one question at a time
• Begin with open-ended and non-leading questions
• PAUSE – wait for and LISTEN TO response
• Confirm understanding with restatement or
paraphrasing strategies

102
Q

What are open ended questions?

A

Questions that allows the patient elaborate on their answers

103
Q

Definition of encoding barriers?

A

The process of selecting and organizing symbols to represent a message requires skill and knowledge.

104
Q

What are the obstacles that can interfere with an effective message?

A
  • Lack of Sensitivity to Receiver
  • Lack of Basic Communication Skills
  • Insufficient Knowledge of the Subject.
  • Information Overload
  • . Emotional Interference
105
Q

Transmitting barriers are…

A

Things that get in the way of message transmission are sometimes called
“noise.”

106
Q

Types transmitting barriers

A
  • Physical Distractions
  • Conflicting Messages
  • Channel Barriers
  • Long Communication Chain
107
Q

Decoding Barriers. The communication cycle may break down at the receiving end for some of these
reasons:

A
  • Lack of Interest
  • Lack of Knowledge
  • Lack of Communication Skills
  • Emotional Distractions
  • Physical Distractions
108
Q

Responding Barriers—The communication cycle may be broken if feedback is unsuccessful:

A
  • No Provision for Feedback

- Inadequate Feedback

109
Q

What are the 4 categories of non-verbal communication?

A

Physical
Aesthetic
Signs
Symbolic

110
Q

What is physical non- verbal communication?

A

This is the personal type of communication. It includes facial expressions, tone of voice, sense of touch, sense of smell, and body motions.

111
Q

What is aesthetic non- verbal communication?

A

This is the type of communication that takes place through creative expressions: playing instrumental music, dancing, painting and sculpturing

112
Q

What is signs non- verbal communication?

A

This is the mechanical type of communication, which includes the use of signal flags, the
21-gun salute, horns, and sirens.

113
Q

What is symbolic non- verbal communication?

A

This is the type of communication that makes use of religious, status, or ego-building symbols.

114
Q

What are the static features of non- verbal communication?

A

Distance
Orientation
Posture
Physical contact

115
Q

Static feature: Distance is characterized by…

A

The distance one stands from another frequently conveys a non-verbal message. In
some cultures it is a sign of attraction, while in others it may reflect status or the intensity of the exchange.

116
Q

Static feature: orientation is characterized by…

A

People may present themselves in various ways: face-to-face, side-to-side, or even back-to-back. For example, cooperating people are likely to sit side-by-side while competitors
frequently face one another

117
Q

Static feature: posture is characterized by…

A

Are we slouched or erect? Are our legs crossed or our arms
folded ? Such postures convey a degree of formality and the degree of relaxation in the
communication exchange.

118
Q

Static feature: physical contact is characterized by…

A

Shaking hands, touching, holding, embracing, pushing, or patting on the back
all convey messages. They reflect an element of intimacy or a feeling of (or lack of) attraction.

119
Q

What are the dynamic features of non- verbal communication?

A
  • Facial expressions
  • Gestures
  • Looking
120
Q

Dynamic feature: facial expressions is characterized by…

A

A smile, frown, raised eyebrow, yawn, and sneer all convey information. Facial expressions continually change during interaction and are monitored constantly by the recipient. There is evidence that the meaning of these expressions may be similar across cultures.

121
Q

Dynamic feature: gestures is characterized by…

A

One of the most frequently observed, but least understood, cues is a hand movement. Most people use hand movements regularly when talking. While some gestures (e.g., a clenched
fist) have universal meanings, most of the others are individually learned and idiosyncratic.

122
Q

Dynamic feature: looking is characterized by…

A

A major feature of social communication is eye contact. It can convey emotion, signal
when to talk or finish, or aversion. The frequency of contact may suggest either interest or boredom.

123
Q

Definition of non-verbal communication according to Tortoriello, Blott, and DeWine

A

”. . . the exchange of messages primarily through non-linguistic means, including: kinesics (body language), facial expressions and eye contact, tactile communication, space and territory, environment, paralanguage (vocal but non-linguistic cues), and the use of silence and time.”

124
Q

Empathic communication is described by Coulehan et al as…

A

language that aides the process of healing by bolstering patient’s strengths, validating their perspective, and teaching them how to grow to be more self-reliant

125
Q

What are the habits in the 4- habit model?

A
  • Invest in the beginning
  • Elicit the patient’s perspective
  • Demonstrate empathy
  • Invest in the end
126
Q

Characteristics of : Invest in the beginning

A
  • Create rapport quickly
  • Elicit patient concerns
  • Plan the visit with the patient
127
Q

Characteristics of : Elicit the

patient’s perspective

A
  • Ask for patient ideas
  • Elicit specific requests
  • Explore the impact on the
    patient’s life
128
Q

Characteristics of: Demonstrate

empathy

A
  • Be open to patient’s emotions
  • Make at least one empathic
    statement
  • Convey empathy nonverbally
  • Be aware of your own
    reactions
129
Q

Characteristics of: Invest in the

end

A
  • Deliver diagnostic information
  • Provide education
  • Involve patient in making
    decisions
  • Complete the visit

PT fundamentals (8 decks)

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